Department of Neonatology, Yerevan State Medical University, 2 Koryun St, 0025, Yerevan, Armenia.
Division of Pediatrics, Transportation and Neonatal Critical Care, "A. Béclère" Medical Center, South Paris, University Hospitals, APHP, Paris, France.
Eur J Pediatr. 2020 Jul;179(7):1131-1137. doi: 10.1007/s00431-020-03603-w. Epub 2020 Feb 14.
Despite neonatal lung ultrasound (LU) being diffused worldwide, its introduction in limited-resource areas has not been formally investigated. We conceived a project to introduce it in a level 3 NICU of a developing country and verify if, after a short protocolized training, clinicians may efficaciously use LU. Inter-rater agreement between ultrasound trainees and trainers was analyzed within both the local test and the diffusion phases of the project. High inter-rater agreements were found between expert trainers and the two neonatologists who were trained in a skilled European center (Cohen's Kappa, 0.951; 95%CI, 0.882-0.999), as well as between the two and the second round of locally trained colleagues (Cohen's Kappa, 0.896; 95%CI, 0.797-0.996). Moreover, a high agreement was found between the clinical respiratory diagnosis (used as the "gold standard") and the LU diagnosis given by the first two trainees (intraclass correlation, 0.992; 95%CI, 0.987-0.996) and the locally trained physicians (intraclass correlation, 0.97; 95%CI, 0.95-0.98). A final survey demonstrated that the project was perceived as efficacious and that LU was going to be integrated into routine clinical practice.Conclusions: А short LU training provided sufficient proficiency and allowed the LU introduction in clinical practice in the neonatal intensive care unit in a developing country.What is Known:• Lung ultrasound is a promising technique for evaluating neonatal respiratory distress at least in high-income countries. Previous studies revealed high specificity and sensitivity in diagnosing specific neonatal disorders.• An important barrier to the more extensive use of lung ultrasound in neonatal critical care is a lack of efficient and suitable training solutions.What is New:• Descriptive LU performed by neonatologist in a developing country after a short formal training is feasible with good quality.• A short formal LU training program provided good proficiency and allowed a correct descriptive diagnosis in a neonatal unit in a developing country.
尽管新生儿肺部超声（LU）已在全球范围内普及，但在资源有限的地区引入该技术尚未得到正式研究。我们设计了一个项目，旨在将其引入发展中国家的三级新生儿重症监护病房（NICU），并验证经过短期规范化培训后，临床医生是否能够有效地使用 LU。在项目的本地测试和推广阶段，分析了超声培训师和培训师之间的观察者间一致性。在专家培训师和在熟练的欧洲中心接受培训的两名新生儿科医生之间（Cohen 的 Kappa，0.951；95%CI，0.882-0.999），以及在这两名医生和第二轮接受本地培训的同事之间（Cohen 的 Kappa，0.896；95%CI，0.797-0.996），观察者间一致性均较高。此外，临床呼吸诊断（用作“金标准”）与前两名受训者给出的 LU 诊断之间（组内相关系数，0.992；95%CI，0.987-0.996）和接受本地培训的医生之间（组内相关系数，0.97；95%CI，0.95-0.98）的一致性也很高。最终的调查表明，该项目被认为是有效的，并且 LU 将被纳入发展中国家新生儿重症监护病房的常规临床实践。
短期 LU 培训提供了足够的熟练度，并允许在发展中国家的新生儿重症监护病房将 LU 引入临床实践。
肺部超声是评估新生儿呼吸窘迫的一种有前途的技术，至少在高收入国家是如此。先前的研究表明，该技术在诊断特定新生儿疾病方面具有较高的特异性和敏感性。
新生儿重症监护中广泛应用肺部超声的一个重要障碍是缺乏有效的、合适的培训解决方案。
在发展中国家，经过短期的正式培训，由新生儿科医生进行描述性 LU 是可行的，且具有较高的质量。
短期的正式 LU 培训计划提供了良好的熟练度，并允许在发展中国家的新生儿病房进行正确的描述性诊断。
